Healthcare Provider Details

I. General information

NPI: 1548679285
Provider Name (Legal Business Name): RANDI WALTERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RANDI REASON

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 CAMINO DEL RIO S
SAN DIEGO CA
92108-3806
US

IV. Provider business mailing address

3255 CAMINO DEL RIO S
SAN DIEGO CA
92108-3806
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-3500
  • Fax: 858-799-0801
Mailing address:
  • Phone: 858-694-3500
  • Fax: 858-799-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number93437
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number73314
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW93437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: